Janet B. Hardy

Evaluation of a pregnancy prevention program for urban teenagers.

This article reports on a school-based program for the primary prevention of pregnancy among US inner-city adolescents that was designed and administered by the staff of the Johns Hopkins School of Medicines Department of Gynecology and Obstetrics. 4 schools in the Baltimore school system--2 junior high schools and 2 senior high schools--participated. The program provided the students attending one of the junior high schools and one of the senior high schools with sex and contraceptive education individual and group counseling and medical and contraceptive services over a period of almost 3 school years. The other 2 schools served as controls. A survey was conducted to ascertain knowledge attitudes and behavior of the students. The junior high school in which the pregnancy prevention program was introduced is a community school serving an all-black inner-city population. At the baseline survey 667 male students and 1033 female students completed the questionnaire. At the final survey nearly 3 years later 506 male students and 695 female students answered the questionnaire. The baseline survey data revealed high levels of sexual activity in both the program and the nonprogram schools. Almost 92% of boys in the 9th grade of the program junior high school were sexually active as were 54% of the comparable girls. More overall improvement would be gained by helping students holding positive attitudes toward pregnancy prevention translate those attitudes into action than by attempting to change the attitudes of the few who do not share that view. A large proportion of both male and female students cited an ideal age for childbearing that was lower than the age they considered ideal for marriage. After exposure to the program the % decreased among the girls but not the boys. The proportion of sexually active students in the program schools who attended a clinic rose at all grade levels for both male and female students. At the baseline survey pill use was found to increase with age. After exposure to the program the % using the pill increased among all grade levels. Use of no contraceptive method at last intercourse was reduced to extremely low levels after exposure to the program. After 20 months of exposure to the program the conception rate fell by 22.5%. The program led to decreases in the pregnancy rates of 9th-12th grade students.

Like Mother, Like Child: Intergenerational Patterns of Age at First Birth and Associations with Childhood and Adolescent Characteristics and Adult Outcomes in the Second Generation.

A 30-year follow-up of 1,758 inner-city children and their mothers in the Pathways to Adulthood Study revealed significant associations in transgenerational timing of age at 1st birth between mothers and their daughters and sons. Intergenerational age patterns were associated with the childrens family and personal characteristics during childhood and adolescence and self-sufficiency at age 27-33. Continuity in teenage parenthood was associated with family and personal characteristics unfavorable for optimal child development and successful adult outcomes. Delay in 1st parenthood to age 25 or older was associated with significantly greater odds of more favorable environmental and developmental characteristics and greater adult self-sufficiency. The authors concluded that age at 1st birth of both mothers and children contributes, but in subtly different ways for daughters and sons, to the childrens development and adult self-sufficiency.

Substance use and its relation to sexual activity among inner-city adolescents.

A study of inner-city Black and Caucasian males and females in two junior and two senior high schools provided data on sexual knowledge, attitudes and behaviors, and substance use based on over 2500 anonymous, voluntary self-administered questionnaires. Substance use was high among Caucasians, particularly females. Females smoked more cigarettes than males and men drank more alcohol. Marijuana smoking showed only small racial, age, and gender differences. Compared to Blacks, Caucasians used more hard drugs. Using an index scoring types of substances and frequencies of use, sexually active students were higher than virgins in all subgroups, with those who initiated intercourse early appearing highest on the index. A regression model explaining 21% of the variance in substance use showed independent effects of age, race, gender, and sexual activity. The importance of an index for screening early use is discussed, and research on the relationship of low-level youthful experimentation with future dysfunctional use is proposed.

Toxicity to bilirubin in neonates: Infant development during first year in relation to maximum neonatal serum bilirubin concentration****

Neurologic and developmental performance during the first year of life was correlated with maximum neonatal serum bilirubin levels for 27,000 infants in the Collaborative Perinatal Project. The infants were grouped by race and by five birth weight/gestational age categories to control for the effect of these factors on hyperbilirubinemia and developmental outcome. Low mean eight-month motor scores and delayed one-year motor development were associated with serum bilirubin levels in the range of 10 to 14 mg/dl and above. This relationship was strongest for low-birth-weight/short-gestational-period infants. A persistent association of developmental outcome with hyperbilirubinemia was found over and above the variation of maturity within the birth weight/gestational age categories.

Long-range outcome of adolescent pregnancy.

The Johns Hopkins Child Development Study (JHCDS) begun in 1959 provided prospective multidisciplinary longitudinal data on factors affecting child development. Children of adolescent mothers were compared with those of older mothers over a period of 12 years postpartum. The risk of perinatal death was not significantly higher for babies of adolescent mothers but infant mortality was proportionately greater for the babies of mothers 17 or less. The greatest risk of perinatal death was experienced by women over 35. A greater proportion of the babies of adolescent mothers had low birth weights. Measured at ages 4 7 and 12 the children of adolescent mothers performed less well on standardized intelligence and psychological tests. It is concluded that the older women had as a group been able to establish more stable marriages and more favorable family environments in which to raise their children. Such factors as attained socioeconomic status marital status employment subsequent fertility and sources of income were measured.

Correlation of neonatal serum total bilirubinconcentrations and developmental status at age eight months

Through the Collaborative Study on Cerebral Palsy of the National Institute of Neurological Diseases and Blindness, 23,000 infants 8 months of age have been observed from birth through June 30, 1964. The findings appear to indicate a positive relationship between increasing neonatal hyperbilirubinemia and the incidence of low motor and/or mental scores attained at 8 months. These relationships do not begin abruptly at the 20 mg. per cent level but may be seen to rise progressively and to become substantial at the 16 to 19 mg. per cent concentration. Since this study will ultimately include 60,000 infants who are to be followed through the age of 7 years, this is a preliminary report both as to the number of cases studied and as to the final outcome for the child.

Adolescent sexual attitudes and behavior: are they consistent?

Relationships between sexual attitudes and behavior among adolescents were studied in data collected by self-administered questionnaires from approximately 3,500 junior and senior high school students attending four inner-city schools during 1981-1982. An analysis of the results by sex, race and age found that 83 percent of sexually experienced adolescents cite a best age for first intercourse that is older than the age at which they themselves experienced that event, and 43 percent of them report a best age for first coitus older than their current age. In addition, 88 percent of young women who have had a baby say the best age at which to have a first birth is older than the age at which they first became mothers. Thirty-nine percent of the women and 32 percent of the men say that they believe premarital sex is wrong. Among those who are virgins, the proportions are much higher. However, even among those who have had intercourse, approximately 25 percent of both sexes say they believe sex before marriage is wrong. Women desire stronger relationships before having intercourse than do men, and women claim to have had a stronger relationship with their last sexual partner. Very few teenagers believe neither partner is responsible for pregnancy prevention, which tends to be viewed as a joint responsibility. Those who see it as a shared responsibility are slightly more likely than those who assign the responsibility to one or the other partner to have used a method at last intercourse, and they are considerably more likely to have used a method than are those who believe contraception is neither partners responsibility.(ABSTRACT TRUNCATED AT 250 WORDS)

Teenage fathers and the fathers of infants of urban, teenage mothers.

Data from Certificates of Live Birth, for recorded resident births in Baltimore in 1983, were used to describe fathers whose child was born to a teenage mother. Four groups were identified: 1) both father and mother were teenagers (12 per cent); 2) only the mother was a teenager (14 per cent); 3) only the father was a teenager (2 per cent); 4) both parents were aged 20 years of above (72 per cent). The fathers in the first three groups appeared at serious educational and financial disadvantage as compared with those where neither parent was a teenager. Within the teenage parent groups, White fathers had lower educational attainment than Black; one in four White fathers was married vs less than 5 per cent of Black. Although limited in scope, the data indicate that disadvantages associated with being a teenage father or the father of an infant born by a teenage mother are clear cut.

Fathers of children born to young urban mothers.

Fathers of babies born to a sample of urban mothers younger than 18 at delivery ranged in age from 14-50 and were, on average, 2-4 years older than the mothers. Among the adolescent women who had given birth to their first child, 28 percent of the partners of black women and 45 percent of the partners of white women were 20 years of age or older. The educational attainment of the fathers was very low, particularly among older whites. At approximately 15 months after the childs birth, 36 percent of the fathers were neither in school nor working. Three-quarters of the pregnancies among the young white mothers and 95 percent of those among the black mothers were unplanned, but only six percent of the white mothers and 16 percent of the black mothers were using a contraceptive at the time of conception. Only 16 percent of the fathers were living with or married to the mother of their child at 15 months after birth. About 90 percent of the fathers had spent time with their child during that period, but frequency of contact declined markedly with time. Overall, 20 percent of the fathers had children by other women.

Serum immunoglobulin levels in newborn infants. II. Survey of cord and follow-up sera from 123 infants with congenital rubella

The value of determining serum immunoglobulin levels as a screening test for intrauterine infection was evaluated in 123 infants with documented congenital rubella and in control subjects. Data collected from cord blood and from specimens obtained during the first 36 months of life were submitted to statistical analysis. Elevation of cord IgM values (20 mg. per cent or above) was noted in only 18 per cent of infants with rubella, and principally in those who had the more severe and usually clinically recognized manifestations of congenital rubella. Immunoglobulin values in sera collected during the first 6 months of life were elevated in approximately half of the infants tested and in those with mild illness as commonly as those with severe illness.